Mahadik Akshada, IJRPS 2020, 10(2), 12-16

IJRPS, 10(2) July – Sep., 2020 Page 12

Review article Available online www.ijrpsonline.com ISSN: 2249–3522

International Journal of Research in Pharmacy and Science

How to Deal with Pregnancy During Covid-19

Mahadik Akshada

Department of Community Medicine, JNMC, DMIMS, Wardha (Sawangi)

442004; Maharashtra, India

Contact no. – 7776083049; Email ID – mahadik.akshada@gmail.com

___________________________________________________________________________________

ABSTRACT –

COVID-19 disease has put us all in worldwide alarming situation. The causative agent is severe

acute respiratory syndrome coronavirus-2 (SARS-cov-2). COVID 19 infection in a pregnant lady can

show more severe symptoms. Precautionary methods like hand washing, wearing mask, social distancing

must be done. In order to avoid the contact as much as possible. Routine ANC visits should be avoided

and consultation with doctor should be initiated over phone calls.

Any pregnant women positive with covid19 while in labour, obstetrics, anaesthetic or neonatal

interventions should be followed as per standard practice. There is no contraindication for epidural or

spinal anaesthesia. But general anaesthesia should not be done as there is high risk of transmission while

during intubation. The pregnant patients who are not in labour and positive for covid19 should be given

supportive and symptomatic treatment. Antiviral regimens or combinations of hydroxychloroquine with

azithromycin has shown some positive results. During post delivery time, the newborn should be kept

away from the positive mother for a temprory period but expressed breat milk can be given to the

newborn.

KEYWORDS – COVID-19, Pregnancy, Guidelines, Community health

____________________________________________________________________________________

*Corresponding author

Dr. Akshada Mahadik

Medical Intern, MBBS Batch 2015, Department of Community Medicine, JNMC, DMIMS,

Wardha (Sawangi) 442004; Maharashtra, India

Contact no. – 7776083049; Email ID – mahadik.akshada@gmail.com

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INTRODUCTION –

The Global pandemic covid19 which is caused by severe acute respiratory syndrome

coronavirus-2 (SARS-CoV-2), is a single stranded RNA enveloped virus.

Risk of infection in a pregnant women is same as that of general population but in pregnancy is a state of

immunosuppression and along with other changes like physiological, respiratory and immune that’s why

in pregnant women more severe symptoms of covid19 infection can be seen.

DISCUSSION –

Prevention and Precaution –

Routine ANC visits for the uninfected patients can be postponed and can be telephonic or web

consultation for minor complaints and doubts.

Important visits for the 12 and 19 weeks scans are needed. Women must monitor their daily fetal

movement count. The next visit could be at 32 weeks pregnancy. As per ICMR, criteria for doing

laboratory test are –

1) Pregnant women showing symptoms of having acute respiratory illness with one of the

following: history of migrating in the last 2 weeks these individuals and their family living

together in the same home should home quarantine for 14 days. Any person who has come in

contact with any laboratory proven positive patient or any healthcare worker who has been

hospitalized with symptoms of severe acute respiratory illness.

2) Pregnant women residing in hotspot or containment area who is in labour or those who have date

of delivery in the next few days should be tested for covid19 even if asymptomatic (strategy for

covid-19 testing for pregnant women in India).

Asymptomatic pregnant women should also be tested after coming into direct contact of covid19

positive individual. Tests should be done repeatedly to confirm the diagnosis. Two consecutive negative

samples should be taken 24 hrs apart rules out covid19.

Serological testing as a diagnostic procedure can also be done if other procedures are not

available on time. Samples for other viruses, bacterial pneumonia, chlamydia and mycoplasma

pneumonia should be tested. Blood cultures should be taken to rule out secondary infections.

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Management –

All patients should treated as confirmed covid19 cases, until the results available. These should

not be any delay in the obstetric management while they are being tested. Separate setup and staff should

be provided for the delivery of highly suspected to be positive and covid19 positive patients.

If any pregnant patient with confirmed ciovid19 status arrives, a registry should be maintained.

For Pregnant Women not in Labour –

Supportive therapy for covid19 includes rest, oxygen supplementation, fluid management and

nutritional care.

Hydroxychloroquine in dose of 600mg (200mg TDS) and azithromycin (500mg OD) for 10

days. Lopinavir-ritonavir is the first antiviral combination, lopinavir for 400mg and ritonavir for 100mg

should be given TDS daily for 14 days. Steroids for fetal lung maturity between 24-34 weeks of

gestation. If secondary bacterial infection persists, antibiotic which are non-teratogenic can be given.

Intensive Care –

Patient should be kept in observation. Pulse, blood pressure, respiratory rate, oxygen flow to

titrated to keep SpO2 >94%. Fetal heart rate monitoring should be done.

For Pregnant Women in Labour –

If pulmonary involvement is there then beta- agonists should be avoided. There is no indication

of termination of pregnancy in presence of covid19 as there is no risk of transmission to fetus. But in

case of critically ill patient, to relieve metabolic and pulmonary load, pregnancy can be terminated.

During labour, strict vigil to be maintained for breathlessness, tachypnoea and tachycardia or

hypoxia, intensive care may be required anytime. IV fluids should not be given. Electronic fetal

monitoring should be done continuously.

Second stage of labour should be cut short to prevent mother from exhaustion and to prevent

mother from putting extra efforts if there is respiratory involvement. Some theories recommend

immediate cord clamping where as some says delayed cord clamping is better.

Neonatal resuscitation table should be kept away (atleast 2 metres) from delivery table.

Epidural or spinal anaesthesia minimizes the need of general anaesthesia if urgent delivery id needed.

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Postnatal Care –

There is a major risk of transmission through contact with maternal infectious respiratory

secretions. Newborn should be kept away temprorily from the covid19 positive mothers. If there is no

one other than mother to take care of newborn then, mother should put on a facemask which should

remain intact and do hand hygiene before each feed and other close contact with the newborn.

During temprory separation, breastfeed should be initiated through expressing of breastmilk using breast

pump. All precautions should be taken so that breast milk do not get contaminated.

CONCLUSION –

Suitable management should be provided in order to give support to pregnant covid19 patient

with adequate protection for healthcare workers.

Clinical recommendation should be derived from the current practice rather than from previous

epidemics.

Pregnancy is a high risk group for this infection and all the precautions should be taken to

prevent the spread to newborn.

ACKNOWLEDGEMENT –

I am grateful and thankful to Dr. Swarupa Chakole Ma’m, Professor and all other staff of

Department of Community Medicine, JNMC for all the support and advices which has helped me to

clear the concepts regarding this article.

CONFLICTS OF INTEREST –

There is no confict of events with these topics.

FUNDING –

No funding has been provided.

REFERENCES –

1. Coronavirus disease (COVID-19) pandemic – WHO.int. April 2020

https://www.who.int/emergencies/diseases/novel-coronavirus-2019

2. Social distancing advisory by MOHFW. April 21, 2020

https://www.mohfw.gov.in/SocialDistancingAdvisorybyMOHFW.pdf.

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3. Good clinical practice recommendation on pregnancy with covid19 infection. FOGSI April 2020

https://www.fogsi.org?wpcontent/uploads/covid19/fogsi_gcpr_on_pregnancy_with_COVID_19_

version_1.pdf.

4. Advisory on use of hydroxychloroquine prophylaxis by ICMR 2020

https://www.mohfw.gov.in/pdf/AdvisoryontheuseofHydroxychloroquinasprophylaxisfor

SARSCoV2infection.pdf

5. ICMR – National Institute for research in Reproductive Health Guidance for Management of

Pregnant Women in COVID-19 Pandemic. April, 2020. https://www.nirrh.res.in/wp-

content/uploads/2020/04/Guidance-for-Management-of-Pregnant-Women-in-COVID-19-

Pandemic.pdf

6. ICMR – Covid19 testing. April, 2020

https://icmr.nic.in/sites/default/les/upload_documents/2020-03-20_covid19_test_v3.pdf

7. Liang H, Acharya G. “Novel corona virus disease (COVID-19) in pregnancy: What clinical

recommendations to follow?”, Acta Obstet Gynecol Scand. 2020.